Porcini LLC Wild Rose Living

Primary specialty

Custodial Care FacilityTaxonomy code 311Z00000X

Legal business name

PORCINI LLC WILD ROSE LIVING

Practice address

1172 Wild Rose Dr
Santa Rosa, CA 95401-5058

Phone

(707) 291-5756

Fax

(707) 838-0820

NPI assigned

Aug 29, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Pamela JohnsonNPI 1619860020

Title

Managing Member/Administrator

Phone

(707) 291-5756

Specialties & licenses 1

Addresses

Other names 1

• Wild Rose Living Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Pamela Johnson

  • Custodial Care Facility
  • Santa Rosa, CA
  • NPI 1619860020
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1756425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763596800000",
    "number": "1538048962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1172 WILD ROSE DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954015058",
            "telephone_number": "707-291-5756",
            "fax_number": "707-838-0820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1172 WILD ROSE DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954015058",
            "telephone_number": "707-291-5756",
            "fax_number": "707-838-0820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORCINI LLC WILD ROSE LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-29",
        "last_updated": "2025-11-20",
        "certification_date": "2025-11-20",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "MANAGING MEMBER/ADMINISTRATOR",
        "authorized_official_telephone_number": "707-291-5756"
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wild Rose Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mark J Popovich, M.D.
• Christa Poppe
• Amy Marie Popplewell, NP
• Noely Porcayo-Paredes, LCSW
• Emily Lizabeth Porch, M.D.
• Junelle Barrett Porter
• Laura W. Porter
• Michelle A. Porter
• Sharon Valley Porter, MSN, APRN, FNP-BC
• Rochelle Frances Porzio, M.P.T

• Custodial Care Facility in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Custodial Care Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.